Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification

Krasnalhia Lívia S de Abreu, Geraldo B Silva Júnior, Adller G C Barreto, Fernanda M Melo, Bárbara B Oliveira, Rosa M S Mota, Natália A Rocha, Sônia L Silva, Sônia M H A Araújo, Elizabeth F Daher, Krasnalhia Lívia S de Abreu, Geraldo B Silva Júnior, Adller G C Barreto, Fernanda M Melo, Bárbara B Oliveira, Rosa M S Mota, Natália A Rocha, Sônia L Silva, Sônia M H A Araújo, Elizabeth F Daher

Abstract

Background: Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the prevalence, clinical characteristics and outcome of AKI after trauma.

Patients and methods: This was a retrospective study performed from January 2006 to January 2008 in an emergency specialized hospital in Fortaleza city, northeast of Brazil. All patients with AKI admitted in the study period were included. Prevalence of AKI, clinical characteristics and outcome were investigated.

Results: Of the 129 patients admitted to the intensive care unit (ICU), 52 had AKI. The mean age was 30.1 ± 19.2 years, and 79.8% were males. The main causes of AKI were sepsis in 27 cases (52%) and hypotension in 18 (34%). Oliguria was observed in 33 cases (63%). Dialysis was required for 19 patients (36.5%). Independent risk factors associated with AKI were abdominal trauma [odds ratio (OR) = 3.66, P = 0.027] and use of furosemide (OR = 4.10, P = 0.026). Patients were classified according to RIFLE criteria as Risk in 12 cases (23%), Injury in 13 (25%), Failure in 24 (46%), Loss in 1 (2%) and End-stage in 2 (4%). Overall in-hospital mortality was 95.3%. The main cause of death was sepsis (24%). Mortality was 100% among patients with AKI.

Conclusions: AKI is a fatal complication after trauma, which presented with a high mortality in the studied population. A better comprehension of factors associated with death in trauma-associated AKI is important, and more effective measures of prevention and treatment of AKI in this population are urgently needed.

Keywords: Acute kidney injury; mortality; outcome; risk factors; trauma.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Comparison of mean serum creatinine in different occasions in patients with acute kidney injury after trauma, who required renal replacement therapy and those who did not require (non-RRT)
Figure 2
Figure 2
Comparison of mean serum urea in different occasions in patients with acute kidney injury after trauma, who required renal replacement therapy and those who did not require

References

    1. Kellum JA. Acute Kidney Injury. Crit Care Med. 2008;36:141–5.
    1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.
    1. Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50:811–8.
    1. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ. Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med. 1996;24:192–8.
    1. Morris JA, Mucha P, Ross SE, Moore BF, Hoyt DB, Gentilello L, et al. Acute posttraumatic renal failure: a multicenter perspective. J Trauma. 1991;31:1584–90.
    1. Regel G, Lobenhoffer R Grotz M, Pape HC, Lahmann, Tscherne H. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at German level I trauma center. J Trauma. 1995;38:70–7.
    1. Nadvi SS, Mokoena T, Gouws E, Haffajee AA. Prognosis in post-traumatic acute renal failure is adversely influenced by hypotension and hyperkalemia. Eur J Surg. 1996;162:121–4.
    1. Mehta RL, Pascual MT, Soroko S, Chertow GM. PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53.
    1. Ympa YP, Sakr Y, Reinhart K, Vincent J. Has mortality from acute renal failure decreased?.A systematic review of the literature. Am J Med. 2005;118:827–32.
    1. Menashe PI, Ross SA, Gottlieb JE. Acquired renal insufficiency in critically ill patients. Crit Care Med. 1988;16:1106–9.
    1. Stene JK. Renal failure in trauma patients. Crit Care Clin. 1990;6:111.
    1. Letteri JM. Post-traumatic acute renal failure. Adv Exp Med Biol. 1987;212:211–8.
    1. Thadani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996;30:1448–59.
    1. Mason JC, Joeris B, Welsch J, Kriz W. Vascular congestion in ischemic renal failure: the role of cell swelling. Miner Electrolyte Metab. 1989;15:114–24.
    1. Vetterlein F, Petho A, Schmidt G. Distribution of capillary blood flow in the rat kidney during postischemic renal failure. Am J Physiol. 1986;215:510–9.
    1. Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality - a cohort analysis. JAMA. 1996;275:1489–94.
    1. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, Definitions for sepsis and organ failure and guidelines for the need of innovative therapies in sepsis. Crit Care Med. 1992;20:864–74.
    1. Kellum JA, Bellomo R, Ronco C. Classification of acute kidney injury using RIFLE: what’s the purpose? Crit Care Med. 2007;35:983–4.
    1. Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow GM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol. 2002;13:1350–7.
    1. Silva GB, Jr, Daher EF, Mota RMS, Menezes FA. Risk factors for death among critically ill patients with acute renal failure. São Paulo Med J. 2006;124:257–63.
    1. Cury F, Baitello AL, Echeverria RF, Espada PC, Godoy JM. Rates of thoracic trauma and mortality due to accidents in Brazil. Ann Thorac Med. 2009;4:25–6.
    1. Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Diuretics and mortality in acute renal failure. Crit Care Med. 2004;32:1669–77.
    1. Brown CV, Dubose JJ, Hadjizacharia P, Yanar H, Salim A, Inaba K, et al. Natural History and Outcomes of Renal Failure after Trauma. J Am Coll Surg. 2008;206:426–31.
    1. Gettings LG, Reynolds HN, Scalea T. Outcome in posttraumatic acute renal failure when continuous renal replacement is applied early vs. late. Intensive Care Med. 1999;25:805–13.
    1. Vivino G, Antonelli M, Moro ML, Cottini F, Conti G, Bufi M, et al. Risk factors for acute renal failure in trauma patients. Intensive Care Med. 1998;24:808–14.
    1. Guly UM, Turney JH. Post-traumatic renal failure, 1956-1988. Clin Nephrol. 1990;34:79–83.
    1. Rasmussen H, Ibels L. Acute renal failure: multivariate analysis of causes and risk factors. Am J Med. 1982;73:211–8.
    1. Kuiper JW, Groeneveld J, Slutsky AS, Plotz FB. Mechanical ventilation and acute renal failure. Crit Care Med. 2005;33:1408–15.
    1. Brown CV, Rhee P, Evans K, Demetriades D, Velmahos G. Rhabdomyolysis after penetrating trauma. Am Surg. 2004;70:890–2.
    1. Honda N. Acute renal failure and rhabdomyolysis. Kidney Int. 1983;23:888–98.
    1. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med. 1988;148:1553–7.
    1. Shustermann N, Strom BL, Murray TG. The risk factors and outcome of hospital-acquired acute renal failure. Am J Med. 1987;83:63–71.
    1. Hou SL, Bushinsky DA, Wish DB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74:243–8.
    1. Bosch X, Poch Esteban, Grau JM. Rhabdomyolysis and Acute Kidney Injury. N Engl J Med. 2009;361:62–72.
    1. Holt SG, Moore KP. Pathogenesis and treatment of renal dysfunction in rhabdomyolysis. Intensive Care Med. 2001;27:803–11.
    1. de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JP. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med. 2003;29:1121–5.
    1. Woodrow G, Brownjohn AM, Turney JH. The clinical and biochemical features of acute renal failure due to rhabdomyolysis. Ren Fail. 1995;17:467–74.
    1. Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: pathophysiology and diagnosis. Eur J Intern Med. 2007;18:90–100.
    1. Wrogemann K, Pena SD. Mitochondrial calcium overload: a general mechanism for cell-necrosis in muscle diseases. Lancet. 1976;1:672–4.
    1. Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol. 2000;11:1553–61.
    1. Cole L, Bellomo R, Silvester W, Reeves JH. A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a “closed” ICU system. Am J Respir Crit Care Med. 2000;162:191–6.
    1. Reinhardt GF, Myscofski JW, Wilkens DB, Dobrin PB, Mangan JE, Jr, Stannard RT. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. J Parenter Enteral Nutr. 1980;4:357–9.
    1. Abernethy VE, Lieberthal W. Acute renal failure in the critically ill patient. Crit Care Clin. 2002;18:203–22.
    1. Schor N. Acute renal failure and the sepsis syndrome. Kidney Int. 2002;61:764–76.
    1. Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med. 2004;351:159–69.
    1. Silvester W, Bellomo R, Cole L. Epidemiology, management, and outcome of severe acute renal failure of critical illness in Australia. Crit Care Med. 2001;29:1910–5.
    1. Harmann PK, Kron IL, McLachaln HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg. 1982;196:594–7.
    1. Brezis M, Agmon Y, Epstein FH. Determinants of intrarenal oxygenation. I. Effects of diuretics. Am J Physiol. 1994;267:1059–62.
    1. Heyman SN, Rosen S, Epstein FH, Spokes K, Brezis ML. Loop diuretics reduce hypoxic damage to proximal tubules of the isolated perfused rat kidney. Kidney Int. 1994;45:981–5.
    1. Mehta RL, Pascual MT, Soroko S, Chertow GM. PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53.
    1. Crowley ST, Peixoto AJ. Acute Kidney Injury in the Intensive Care Unit. Clin Chest Med. 2009;30:29–43.
    1. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73:538–46.
    1. Bagshaw SM, George C, Gibney RT, Bellomo R. A multi-center evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail. 2008;30:581–9.
    1. Yuan F, Hou FF, Wu Q, Chen PY, Xie D, Zhang X. Natural history and impact on outcomes of acute kidney injury in patients with road traffic injury. Clin Nephrol. 2009;71:669–79.
    1. Gomes E, Antunes R, Dias C, Araújo R, Costa-Pereira A. Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality? Scand J Trauma Resusc Emerg Med. 2010;18:1.

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